Shortage or Maldistribution?: In Reply

We appreciate Dr. Bernstein's insightful comments on our article, “Geospatial Study of Psychiatric Mental Health–Advanced Practice Registered Nurses (PMH-APRNs) in the United States.”

We agree with his point that the “scarcity” of PMH-APRNs, especially in rural areas, does not necessarily mean a “shortage.” To effectively quantify “shortage,” we would need additional information about the distribution of mental illness across the country. We mentioned this shortcoming of the study in the Discussion section. Nevertheless, whether it is a “scarcity” or a “shortage,” our finding of an uneven distribution of PMH-APRNs in the United States is important and critical for future educational and public policy.

We have no argument with Dr. Bernstein's suggestions for increasing access by “provision of training to existing primary care practitioners, consultation via telemedicine, and introduction of incentives for mental health specialists.” In fact, we think that he is reinforcing our conclusion (although our focus only on PMH-APRNs may have been a bit narrow).We do make the point that recruitment and education of nurses who currently live in rural areas is one of the best strategies for increasing PMH-APRNsin underserved areas.